Date:

Company Registration and Monitoring Department

Securities and Exchange Commission
Secretariat Building, PICC Complex
Roxas Blvd., Pasay City

Gentlemen:

In compliance with the requirement of Section 126 of the Revised Corporation Code of
the Philippines, the undersigned hereby notifies the Securities and Exchange Commission of a
change in the nominee and alternate nominee of ______________________________, OPC, as indicated in
the Articles of Incorporation, under SEC Reg. No. ___________________.

I, therefore, submit the names of the new nominees and their written consent as follows:

Name Nationality Residence

Nominee: ____________________ ____________________ ____________________
Alternate Nominee: ____________________ ____________________ ____________________

I consent to my appointment as Nominee: _____________________________

(Signature of the nominee)
TIN:

I consent to my appointment as Alternate Nominee: _____________________________

(Signature of the alternate)
TIN:

Certified Correct:
____________________________________________
(Signature and name of the single
stockholder/president)
TIN:

SUBSCRIBED AND SWORN TO before me in ______________ on ___________________ by the above-

named individual as the Single Stockholder/President of the OPC who personally appeared
before me and exhibited to me his/her competent evidence of identity consisting of
_____________________ issued on ____________________.

NOTARY PUBLIC

Doc No. _____;

Page No. _____;
Book No. _____;
Series of _____.